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Alcoholism – What’s It All About?

“If, when you honestly want to, you find you cannot quit entirely, or if when drinking, you have little control over the amount you take, you are probably alcoholic.”

This is one of the descriptions of alcoholism from the book “Alcoholics Anonymous,” referred to affectionately by AA members as the “Big Book.” Notably absent is any requirement for daily indulgence, morning drinking, hard liquor, unemployment, rubbing alcohol consumption, or any of the other characteristics stereotypically associated with alcoholism.

AA’s founders Bill Wilson, and Dr. Robert H. Smith were undeniably alcoholic. Problematic drinking had devastating consequences on their lives, in a multiplicity of ways. Wilson, a one-time successful stock analyst, by his mid-thirties was unemployable, surviving on his wife’s wages as a store clerk, and the generosity of his relatives. Brother-in-law Leonard Strong, a physician, financed four “rehabs” for Wilson at Towns Hospital, a New York facility specializing in the treatment of affluent alcoholics. Wilson was slipping into alcoholic insanity, while, forty pounds underweight, he was simultaneously dying of malnutrition.

Bob Smith was an Akron MD, a surgeon, with a practice that was plummeting as precipitously as his reputation. For over two years, his long-suffering wife, Anne, had been dragging him to the altar of Christian salvation, but no miracle had been forthcoming.

Bill and Bob

Wilson’s first trip to Towns was followed by a period of sobriety. “It relieved me somewhat to learn that in alcoholics the will is amazingly weakened when it comes to combating liquor, though if often remains strong in other respects. My incredible behavior in the face of a desperate desire to stop was explained. Understanding myself now, I fared forth in high hope. For three or four months the goose hung high.”

Of course, Wilson drank again, as have millions of other alcoholics, men and women, young and old, rich and poor. Spouses, children, parents and employers are both frustrated and bewildered. The drinking (or drugging) has ceased for some significant period of time, “normality” seemingly has been restored, but the drinker returns to drink, or the drugger returns to drugs. Everyone is mystified, sometimes the alcoholic/addict himself.

At Towns Hospital, Bill Wilson met a psychiatrist, William Silkworth, who had dedicated his life in a sadly unproductive effort to rehabilitate drunks. Many left his care sober, with a new understanding of the malady, and with hope restored. Almost all drank again, most within a relatively short period of time. Success, defined by long-term sobriety, amounted to only about two percent of his cases.

Asked to contribute a “DOCTOR’S OPINION” to AA’s Big Book, first published 75 years ago, the medical man wrote:

Men and women drink essentially because they like the effect produced by alcohol. The sensation is so elusive that, while they admit it is injurious, they cannot after a time differentiate the true from the false. To them, their alcoholic life seems the only normal one. They are restless, irritable and discontented, unless they can again experience the sense of ease and comfort which comes at once by taking a few drinks – drinks which they see others taking with impunity.

Physiologically different

This returns us to the root problem of alcoholics, the lack of “control over the amount.” Silkworth called this as “the phenomenon of craving… a craving beyond their mental control.” Alcoholics talk about “having a couple,” but are almost totally lacking in the ability to drink moderately. Silkworth was convinced that alcoholics were physically different from the non-alcoholic majority of the population.

One hundred years earlier, an insightful Abraham Lincoln had remarked, “In my judgment such of us who have never fallen victims have been spared more by the absence of appetite than from any mental or moral superiority over those who have. Indeed, I believe if we take habitual drunkards as a class, their heads and their hearts will bear an advantageous comparison with those of any other class.”

The drunkard’s excess of appetite is not a mere moral weakness, but an actual physiological anomaly.

A mental obsession

Unfortunately, the sober alcoholic does NOT return to a state of normalcy, although outward appearances may fail to demonstrate a brewing discontent. Sobriety is a difficult thing to deal with for the untreated alcoholic, and produces, almost inevitably, an existential angst that at some point, pushes to the side all of his well-considered reasons for not drinking.

AA’s second step refers to being restored to sanity. Is the alcoholic insane?

…the main problem of the alcoholic centers in his mind, rather than in his body. If you ask him why he started on that last bender, the chances are he will offer you any one of a hundred alibis. Sometimes these excuses have a certain plausibility, but none of them really makes sense in the light of the havoc an alcoholic’s drinking bout creates… If you draw this fallacious reasoning to the attention of an alcoholic, he will laugh it off, or become irritated and refuse to talk.

Once in a while he may tell the truth. And the truth, strange to say, is usually that he has no more idea why he took that first drink than you have. Some drinkers have excuses with which they are satisfied part of the time. But in their hearts they really do not know why they do it. Once this malady has a real hold, they are a baffled lot. There is the obsession that somehow, someday, they will beat the game. But they often suspect they are down for the count.

AA founder Bill Wilson had his last drink in December, 1934, just prior to his fourth detox at Towns Hospital, and about six weeks before his fortieth birthday. Through an association with a religious organization, the Oxford Group, Wilson’s new ideas of personal powerlessness, were augmented. Turning to God for help, clearing one’s conscience through confession and restitution to others for harm done, were seen as actions which could produce, in the alcoholic, a critical deflation of his childlike self-centeredness.

The most vital of Wilson’s discoveries was that healing comes in helping others.

Men helping themselves by helping others

The Road to Fellowship: The Role of the Emmanuel Movement and the Jacoby Club in the Development of Alcoholics Anonymous

Early in the twentieth century, two Episcopal ministers with doctorates in Psychology began an outreach to the disadvantaged of Boston. Among these, not surprisingly, were many alcoholics. In 1909, church member Ernest Jacoby, a prominent industrialist sponsored gatherings in the church’s basement, specifically for alcoholics. From a humble beginning of a mere six members, this fellowship of alcoholics grew rapidly, with the “Jacoby Club” separating from the “mother” group, the “Emmanuel Movement,” in 1913.

These Boston drunkards found that there was a strength in banding together with others of their ilk, and a great many gained, and maintained, sobriety. The group had weekly meetings, a mentoring program, relaxation techniques, and social events with food, drink and music. The Washingtonian Society had done something very similar in the 1840’s.

The Emmanuel philosophy was characterized by unflagging optimism, and an attempt to infuse positive thinking.

Reverends Worcester and McComb, the Emmanuel founders, were less dogmatic than the preponderance of their colleagues, and they encouraged the afflicted to call upon a “higher Spirit” for assistance. Although the Emmanuels had adopted a “soft-sell,” they were staunchly Christian. A loosening of the religious component of the approach followed the leave-taking of the alcoholics, to form their own distinct fellowship. Lack of success in the original conversion mission was counterbalanced by the efficacy of the rehabilitation enterprise.

The effectiveness of “passing it on” as a means of sustaining sobriety was realized by Worcester and McComb who lobbied for a simple plan of after-care. “Save thyself, save others. Having gained the farther shore, bring others over.”

Even more evocative of an AA that was still thirty years into the future, was the Jacoby Club’s formally adopted slogan, “A Club for Men to Help Themselves by Helping Others.”

AA’s core principle

“Bill’s Story” in the Big Book addresses this vital element:

My wife and I abandoned ourselves with enthusiasm to the idea of helping other alcoholics to a solution of their problems. It was fortunate, for my old business associates remained skeptical for a year and a half, during which I found little work. I was not too well at the time, and was plagued by waves of self-pity and resentment. This sometimes nearly drove me back to drink, but I soon found that when all other measure failed, work with another alcoholic would save the day.

AA is often called a “self-help” group, but more accurately it would be seen as a spiritual fellowship dealing in mutual aid.

In May of 1935, Wilson was five months sober and feeling shaky while out of town on a business trip to Akron, Ohio. A temptation to drink was powerful, and palpable. Seeking out another alcoholic to help, that in doing so, he might help himself, he was led to Dr. Bob Smith, who after a stumble achieved permanent sobriety in June of 1935. Smith also had had periods of sobriety earlier in his life. Months and months.

Contrary to the view of many in the public, and some in our media, these abstinences are not proof of the lack of alcoholism. Returns to drinking after such dry intervals are common, as the problem drinker is propelled toward “the sense of ease and comfort which comes at once by taking a few drinks.” Alcoholics drink too much when they drink – drunken stupors are common, and when they stop, they don’t “stay stopped,” even after professing a “come to Jesus moment.”

The medical community sometimes views alcoholics quite simply as people who continue to drink AFTER drinking has caused life problems.

Not just a river in Egypt

”Denial” is well understood in the modern world as it applies to alcoholism. “I just have a couple.” “I only drink on the weekends.” “I am never drunk at work.” “I don’t drink everyday.” “I don’t NEED it – I can take it or leave it.”

“I am not a perfect human being.”

A great many AA members have been regarding Mayor Ford as “one of us,” for quite some time. Many of us didn’t drink every day, and many retained prominent positions or boasted of stellar employment histories. But – “If, when you honestly want to, you find you cannot quit entirely, or if when drinking, you have little control over the amount you take, you are probably alcoholic.”

Or, you have a “come to Jesus moment” that wears off in a couple of months.

Public misperceptions

Alcoholics Anonymous experienced explosive growth in the 1940’s and 1950’s, largely because of its success in enabling drunkards to maintain sobriety on a long-term basis. Ongoing abstinence is sustained in large part through the “purposefulness” of helping others, and a continuing communion with one’s fellows.

For centuries there have been, from time to time, spectacular “church cures” of the alcoholically afflicted. Sadly, a substantial percentage were not sustained, as the new fellow congregationalists of the redeemed failed to provide a feeling of “fitting in.” A square sober peg in a round dry hole.

To some degree, very old stereotypes of what it is to be an alcoholic persist in the public consciousness, and in the media. Until very recently, Mayor Ford was frequently spoken of on talk radio as a binge drinker, and not, as an alcoholic – the two descriptions seen, it seems, as mutually exclusive. Although it now appears to have been untrue, many Ford defenders have been heard making the claim that the mayor was never drunk at work, but only while “relaxing,” and “on his own time.” AA members understand that among alcoholics, there are a broad array of drinking patterns and behaviors. While some fall to the unfathomable depths, others rise to significant social positions in spite of their vice. These “functioning alcoholics,” understandably, are often seen to stubbornly adhere to their denial. Of course, the great writers, generals, princes, and Prime Ministers are not rendered less alcoholic by their worldly achievements.

The second looming misperception is about treatment. Brother Doug’s recent emotion-clogged speech wished for the mayor “a speedy recovery,” the naïve words of one who “doesn’t get it.” A rehab of 30, 60, or 90 days might be the beginning of something wonderful, although quite frankly, the math is dismal, but it doesn’t “fix” anyone.

I do look forward to the wealth of clichés forthcoming when the Ford campaign resumes.

__________

bob k. is an active Southern Ontario AA member, sober since 1991. He is working to complete a book of essays on the various people who influenced AA history.

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Comments

Alcoholism – What’s It All About? — 13 Comments

Thanks Bob,
I greatly enjoyed your piece. Over the years I have read many essays and reports related to The Emmanuel philosophy,The Jacoby People and others; I find all of this fascinating and humbling that I am part of this ongoing story. Am looking forward to your book of essays on the people who have influenced AA and alcoholism recovery down through the ages.

Great piece, Bob, and thanks! My only suggestion is that it would be more helpful to A.A. if we all dropped the “drinking (or drugging)” and “alcoholic/addict” talk. Legitimating or encouraging this subset among alcoholics (“us and them” from either’s perspective) runs contrary to our singleness of purpose and diminishes the process of identification.

I agree to some degree, sometimes the divisions seem pointless, we’re all addicts trying to get clean. I find it really irritating when members have a problem with someone talking about their drug use, it’s part of their story and they’re entitled to share it in my opinion.

The divisions may serve a purpose though. I’ve had people in AA insinuate that I wasn’t sober when I was still smoking cigarettes. Others project their ideas about sobriety when it comes to anti-depressants and other mood altering prescription drugs. It’s probably good to draw the line with alcohol so as not to open a big can of worms. NA and other 12 step groups seem to be taking care of a lot of issues.

Bob is among my favorite writers. Knowing a little of what it takes to explore aspects of history, measure it against the relative issues of the day, empathize with the zeitgeist of the day and then make contemporary sense out of it, we are about to add a new term to the agnostic lexicon – “the patience of Bob.”

Especially useful to me is your look at the many paths being independently forged and their spooky similarity to each other. The Boston movement to which Peabody emerged is a great example.

Your wry way with words will make your book a standout, Bob. Keep at it, for everyone’s benefit.

Thanks for the history, Bob. I am especially interested in doing an essay on the differences, contradictions, and similarities of the terms: treatment and recovery. I may be working in the “treatment and recovery” field soon and in keeping up my continuing education credits I have asked for those in the hierarchy to do some sort of presentation on this topic. Quite a few of us in recovery, i.e. 12 step fellowships, work in the treatment industry, and I think a presentation on this is needed not only for clients’ clarity but for employees as well. It is a way of thinking that because one is working in the treatment field that it is a part of their own recovery (i.e. carrying the message and practicing these principles in all our affairs), in fact, a large enough part that many ignore meetings and their own inventories, etc and eventually relapse. There are also those who say it should be done “for fun and for free”. The traditions have a lot to say about this. It is just as naïve to believe that one is recovered after treatment and to think that one is in recovery only by working in treatment. I would really like to explore this more and welcome any feedback.

The historical references to other fellowships of drunks, which predated AA’s involvement with the Oxford Group is important history to reflect upon. This is especially true during these days when the “Back to the Basics/Primary Purpose” folks are so ardently trying to revise AA early history to reflect only the Christian principles engendered in the evangelical and pietistic Oxford Group.

It strikes me that the common characteristic of the Washingtonian Movement, the Emanuel Movement and the Jacoby Club, groups of drunks somewhat successful in the century prior to the “Alcoholic Squad” of the Oxford Group began meeting together in both Akron and New York is that “groups of drunks” banded together to help each other stay sober by telling each other their stories. This evolved to become the “Fellowship of the Spirit” (second to last sentence on page 164 of the Big Book), which quite progressively for the time even further evolved to allow women to join the formerly exclusive men’s club !~!~!

I have long believed that the indispensable healing factor operative in AA is not working the steps or studying the Big Book or surrendering to a mythical, superstitious belief in a higher power without or within or having a sponsor who instructs the newcomer how to get sober — rather, it is the identification and support provided by groups of drunk/druggies to each other through the sharing of their experience, strength and hope by relating their stories of recovery. This is what results in ongoing sobriety. Yes, the other factors are important, perhaps even crucially important, but the essence of recovery is our stories in support of each other.

At today’s little meeting of the Portland, Oregon “Beyond Belief Group”, now officially sanctioned by Oregon Area 58 and GSO — our format is currently still in the process of being vetted by the Portland Area Intergroup Central Office — a first time attendee, in her share today used an acronym that previously in my 41st year of continuous recovery I had never heard: H O P E: Hearing Other People’s Experience”

YES !~!~! I’m ever grateful I have also experienced HOPE, since the earliest days of my attending AA meetings in New York City — it’s the essence of what kept me coming back then and why today I still regularly attend AA meetings.

Thanks Bob, as always you help fill out the historical picture for us. Nice to learn about these folks – I had never heard of them.

“The effectiveness of “passing it on” as a means of sustaining sobriety was realized by Worcester and McComb who lobbied for a simple plan of after-care. “Save thyself, save others. Having gained the farther shore, bring others over.”

Nice historically informative post. The misconception section reminds me of a guy going by ‘Orange’ who writes ‘Orange Papers’ about Why AA is Bad, available online if searched. His entire 20 page rant is worse than hostile towards AA; being mostly uninformed, misleading and short-sighted resentments. I know we’re non-believers here, some who don’t even use a higher power when working the steps but we are not burning down AA like ‘Orange’ who is accusing it as a cult, a cause of suicide and breeding ground for sexual predators.
For me, I’m vehemently atheist but I don’t nurse a resentment against AA because I can see they mean well and do affect a positive change for alcoholics seeking help. People’s resentment towards the god in AA is often a reason to drink, nothing more. Plenty of us use the steps without god and we’re sober and humble. Is it unhelpful to newcomers?Yes but what IS helpful to newcomers? Not much until thoroughly beaten by the beast into a genuine desire to quit, then the steps keep us on track. Though I’m atheist and openly profess it in meetings, I’m amused now when people loathe the religious parallels in AA as if we’re not living in a theocracy nation with Jesus freaks on every corner, what did they expect? Now do you wanna get sober or not? You never needed God.

Another winner from Bob K. Thank you for your research and thoughtfulness.

Trying to get down to brass tacks on what actually works in AA is a tricky business. One route that that may fairly claim some objectivity and a bit of scientific method is historical comparison. That’s why I love essays like this one.

The hope and strength that alcoholics can gather from each other and the purposefulness we find in passing on recovery appear to be the common threads in all the more successful approaches to treatment. When those features are coupled with an honest facing of our our alcoholic condition, the key has turned in the lock.

After that the door to sanity and peace of mind swings open, as Bill Wilson put it in another context, rather easily. And it stays open when we continue to stand by it to welcome others in too.

Once in a while he may tell the truth. And the truth, strange to say, is usually that he has no more idea why he took that first drink than you have. Some drinkers have excuses with which they are satisfied part of the time. But in their hearts they really do not know why they do it. Once this malady has a real hold, they are a baffled lot. There is the obsession that somehow, someday, they will beat the game. But they often suspect they are down for the count.

As a science-trained practicing physician it was difficult to admit not knowing why I was being defeated by my own alcoholism. Only when I acquired full self-acceptance of this humbling fact, did I seem to be able to get on with the business of enjoying life without the desire to fix the potholes with alcohol.

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"Whenever, wherever, one alcoholic meets another alcoholic and sees in that person first and foremost not that he or she is male or female, or black or white, or Christian, Buddhist, Jew, or Atheist, or gay or straight, or whatever, but sees... that he or she is alcoholic and that therefore both of them need each other - there will be not only an Alcoholics Anonymous, but there will be the Alcoholics Anonymous that you and I love so much and respect so deeply."Ernie Kurtz